How DBT Helped in Labor (TW)

This is a bit more of a personal post and has been an ongoing struggle to write.   Up until this month I felt like as a therapist it was unprofessional to write such an intimate blog post.  A student at DBT Path is also pregnant due in a few days and I felt like it would really helpful to share my birth experience with her.  The more I thought about it, started to write then stopped the more I realized it is not unprofessional to write a personal blog post, but rather professional and sincere to share what might be a post that is helpful to others.   Here we go- My Birth Story and how DBT Skills Kept Me Sane

TW- Although I do not get into medical detail, this can be uncomfortable to read for some.

Once I found out I was pregnant I was on what I called the “hippie mom bandwagon.”  I researched doulas in my area and had narrowed down my birthing options to two; home water birth and hospital water birth.  After talking it over with some “hippie mom,” friends I decided the latter provided some reassurance just in case something happened I wouldn't need to travel in the snow last minute in to the hospital.  Little by little my plan came together through talking to close friends, discussing it with my Midwife, endless blog posts, scientific articles and of course good ole’ Google.  I was to have a water birth as well as a four page birth plan I printed off a site that sold organic baby products.  I spent hours preparing for this event; creating a You Tube playlist of both calming mindfulness and upbeat songs for the big push.  I included You Tube videos of DBT skills I planned on using as I packed my hospital bag of herbal medication, lavender and healthy snacks in a cooler. I was prepared at 34 weeks with 6 weeks to spare. I spent the last few weeks on a yoga ball, practicing breathing, taking evening primrose, drinking Red Leaf Raspberry tea (with local honey of course!) and watching more You Tube videos of natural birth than I thought possible.

At my 38 week appointment I had been suffering from an ongoing headache and my blood pressure was elevated, they re-tested and it remained high.  I had some blood drawn to test for preeclampsia and told to call back at 3 for results.  It was unlikely, but I might be induced soon.  I went home and called back.  That was New Year’s Eve and was told to relax, lie on my side, deep breathe and take some Tylenol.  The headache would not go away and I continued to check my blood pressure at home and it remained very high.   I called back the next day and told Labor & Delivery at my hospital that my blood pressure had hit 174/129 and was told to come in for an induction.  I was immediately admitted and told I was suddenly “very high risk,” and might have a seizure at any moment. 

My dreams of a water birth surrounded by the scent of lavender and mindfulness exercises was thwarted when I was put in some heavy duty blood pressure medication and told I was not able to leave the bed, eat or drink until I gave birth and 24 hours after that to continue to prevent seizures.  I took their medical advice (I did try talking them out of how serious it was to not avail) and began a hefty regime of medication.  The cure for preeclampsia is delivery and the OBGYN (buh-bye Midwife) was trying to get my son out ASAP.  The next few hours were a blur or ongoing medical check-ins, a one-on-one nurse, hunger and medication that made me sick to my stomach.  I was admitted at around noon and that night was being told I was not allowed the “hippie haven,” I created.   I panicked and kept thinking suddenly things would be different and I would wake up in the birthing pool to deep breaths and the smell of fresh baby.  

At 10pm that night I had a breakdown- I felt hopeless and skill less.  I had not planned for this and had no clue what to do. I felt like I was losing my sense of control by going along with the process of medical intervention.  My husband slept in the couch next to me in the dark, fresh off of his dinner of a soda and a Snickers bar while I sat and waited and mourned.  I cried, a lot and asked him to hand me the iPad.  I had not updated anyone on what was happening and was unable to see straight because of the meds.  The first thing I did was play my business partner, Debbie Corso’s Conveyor Belt exercise video knowing I needed to begin separating the racetrack of thoughts coming my way.  I shut my eyes and listened, creating buckets including “medical concerns,” “worst case scenarios” and the biggest bucket of them all “the unknown.” I listed to that video twice.   From that I was able to notice that my major fear was the unknown ahead of me and was able to use the Function of The Emotion and identify it as survival and work on Fact Finding- noting I was safe and being well cared for. 

I then decided I needed to Radically Accept the situation- it was beyond my control and the more I tried to fight it or continued to hope that I would wake up in a lavender tub it was not happening.  I cried some more, mourning this lose.  The OBGYN came in to check on me and asked what I wanted to keep in my birth plan- I was shocked.  My black or white thinking lead me to believe I had to give it all up.  I noticed using Wise Mind that I was thinking and acting very emotionally and not being skillful.  I re-drafted my 3 page plan into three important bullet points including having immediate skin to skin contact with my son.  This made me feel more in control of the situation even if I had not moved from the bed in 12 hours.   

I also noticed I was being less than kind to the nursing and other medical staff, partly due to side effects from the medication and a larger part was me being willful and grumpy.  The nurses had done nothing wrong and since I had one-to-one care they were actually being very kind and gentle.  When the nurse returned that morning I used GIVE to ask if I could have some ice since I was so parched and not allowed even water.  She checked with the doctor and I received two cups of joy.   With staff I also utilized Opposite Action and remembered to be kind to others even if I was not feeling well.  I knew I had a long day ahead of me since I was assured I would probably deliver my son next day and knowing I was unable to focus for very long on the iPad screen I googled mindfulness music and listened with my eyes closed until I fell asleep.   I utilized PLEASE skills as best I could and was able to get a few hours of sleep.  I also utilized Building Positive Experiences by trying my hardest to notice the positives; I was healthy and being well cared for, the staff was friendly and knowledgeable and most of all I was going to meet my son soon.    

For the next few hours I focused on Mindfulness and Distress Tolerance skills.  I self-soothed by holding the lavender in my hands and breathing it in as well as listening to some of my favorite songs.  I used the ice in the cup to remain focused, I utilized Mindfulness What skills to observe, describe and participate by releasing the pain with my breathes.  I utilized IMPROVE and took a vacation thinking of the summer’s I spent with my family as a child while it was snowing 6” outside, as well as encouragement by telling myself I can do this.  I utilized DEAR MAN with my husband by telling him to encourage me and even though he is squeamish he was able to help me cheerlead and validate my feelings.  I utilized Half Smile with staff in order to be in a place where I could get my needs meet and be kind to others.   Using Ride the Wave allowed me to handle the physical pain a bit better as well as some of the sudden changed in my treatment that had to be made for the safety of myself and my son.  Lastly I focused on an object in the final moments of labor, which the nurse initiated by telling me to look at her while I pushed.

At 10:17am my son, Javier was born to a set of parents who were able to make the best out of a less than pleasant experience.

Parenting with Borderline

During last week's Twitter "Ask a DBT Therapist" a follower asked if it is possible to "heal" from Borderline.  As we wrote back and forth for a bit she said this line that had stuck with me, "it's a daily struggle even after a lifetime of therapy and self help. I hope my kids don't learn it...l I wonder of they are better off without me."   I spoke with her about people with Borderline Personality Disorder likely have invalidating parents and childhood abuse, which she admitted was true for her case.  I told her she can (mostly) control those 2 factors in her own children and left it there.  5 days later I am still thinking about the statement..

 "I hope my kids don't learn it"

I have not read anything on Borderlines raising children until last Sunday and since then have read just about everything on this subject to speak on it to the Borderline Community. Every article I read from every journal I could find stated that yes parents with Borderline often have issues with their children regarding "attachment and structure" every study involved mothers who were diagnosed as Borderline, but received no intensive mental health services.  There are no studies on those (who like the woman I was talking to on Sunday) have "a lifetime of therapy and self help," no studies on mothers with Borderline whom have done Dialectical Behavioral Therapy (DBT), have grounding techniques, skills or tools.

Tami Green has a Blog where she talks about her own struggles with Borderline Personality Disorder in it she talks to Dr. Blaise Aguiree about those diagnosed with Borderline raising  children.  He came up with this set of 10 guidelines for raising children, which utilizes a lot of DBT skill:

1. Validate your child and teach them to self-validate. Validating is, basically, the ability to articulate to your child that you understand their experience to be true and valid for them. This is key to helping your child learn how to trust himself.

And also, teach your child that no matter what, even the most compassionate humans are limited in their ability to understand an another person's experience. Most people don't set out to be mean and insensitive, and yet they may come across as being so. And also some people are intentionally vindictive. Either way, it is vitally important your children don't expect others to validate who they are, but rather that they learn to validate their own experiences.

2. Teach your child non-judgmental and dialectical thinking. Dialectical thinking is the ability to hold two opposing viewpoints at one time. This discipline develops more effective problem solving, better relationship building, and less black and white thinking (splitting).

3. Give them many opportunities to explore their own unique talents and competences. Guide them towards what you see they like, ask them questions about their preferences, let them make decisions. Get them talking about what is uniquely fun and interesting to them.

4. Know your own self very well. Understand your feelings, beliefs and behaviors and also expect that your child is distinctly different from you.

5. Teach distress tolerance and self-soothing skills. Those with BPD have a hard time regulating their emotions. Rather than reinforcing temper tantrums or backing down from requests just because they seem distressing to your child, teach them how to calm themselves and tolerate these types of interactions.

6. Learn not to react. Keep yourself grounded and model effective, not reactive, behavior. Firm, consistent, calm interactions are the goal.

7. Increase skill-building instruction and opportunities in the areas of: personal responsibility, interpersonal effectiveness, time management, basic finances, and appropriate social responses. On the other hand, and just as important, lower your expectations of them that are not consistent with their true selves and innate value system.

8. Attach consequences to bad decisions and reinforce good decisions. Prepare them for real world living, even if they face real challenges associated with a disability of any kind. Let them know that, even if there are challenges, you have 100% faith in your child having a meaningful life. Part of that belief is knowing you expect them to be able to navigate real-life situations.

9. Teach your child to consider others' feelings, thoughts and behaviors while also firmly holding to a strong understanding of their own needs. It is not an either-or life we live. We can remain firm in our own value system, while also contemplating and accommodating another's belief. How simple, and also how advanced a concept this is.

10. And finally, don't take life too seriously. Life is full of ups and downs. Teach them to go with the flow and don't sweat the small stuff. Life is good and meant to be enjoyed and it all turns out just fine. No one is perfect and life is about learning and growing from our mistakes.

This book was also recommended on most of the articles I found on parents whom have Borderline diagnosis.  I will warn you it's hard to find even online and it's about $50.